眼前段栗刺异物伤临床分析

目的探讨眼前段栗刺异物伤的临床特点、治疗方法及其临床效果。方法对128例（140眼）眼前段栗刺异物伤进行回顾性分析。根据眼前段栗刺异物的不同位置和不同的存留时间而采取角膜深层异物剔除术、角膜或巩膜切开异物摘出术、黏弹剂前房注射静态抽吸法前房异物摘出术、晶状体超声乳化吸出人工晶状体植入联合异物摘出术以及虹膜恢复器顶压异物法。结果140眼眼前段异物全部成功地摘出。91眼（65．00％）术后视力不同程度提高。视力保持不变者49眼（35．00％）。无视力下降者。结论栗刺所致的眼前段异物易引起严重感染，采取恰当的方法彻底清除异物是治疗成功的关键。     

角膜深层栗刺伤异物摘出临床分析

目的 探讨角膜深层栗刺异物伤异物摘出方法及临床效果.方法 对60例（60眼）角膜深层栗刺异物伤进行分析.根据栗刺异物的具体表现分别在裂隙灯显微镜下或手术显微镜下采取镊取法、针剔法、板层角膜瓣法,以及手术显微镜下的经前房顶推法进行异物摘出术.结果 60例角膜深层异物全部摘出且无手术并发症发生.50例（83.3％）视力较初诊时提高,基本维持不变者10例（16.7％）,未见下降者.结论 查清全部异物情况,选择合适的手术方式摘出异物,是角膜深层栗刺异物伤治疗的关键.     

板栗刺致眼外伤的治疗体会

目的总结224例（224眼）板栗刺致眼外伤的治疗体会并作临床分析。方法表麻下在裂隙灯显微镜下，或结膜下浸润麻醉下在手术显微镜下摘出栗刺，术后抗感染，治疗并发症。分析不同的摘出方法，并发症及对视力的影响。结果伤后及时就诊，按照不同的致伤情况采取相应的摘出异物的方法，则可减少并发症，视力恢复较好。结论板栗刺眼外伤在农村发病率高，应加大宣传防护，伤后及时就诊，正确处理。     

眼内异物99例临床分析

目的 通过９９例１０４眼眼内异物临床资料分析，探讨眼内异物摘出合适的手术途径及并发症的治疗。方法 根据异物性质、位置和并发症，选择手术方法。结果 １０４眼中，１６眼经原伤口摘出，３５眼经睫状体平坦部巩膜切口摘出，３５眼经异物原位巩膜切口摘出，１８眼经玻璃体切除术摘出，４眼行眼内容摘除术摘出，３眼异物未摘出，３例转诊。眼内异物摘出率９４％。结论 眼内异物摘出以不进一步损伤眼组织为原则，综合分析异物位     

陕西商洛地区栗刺所致眼外伤256例临床分析

目的 探讨栗刺所致眼外伤的临床特点和治疗方法.方法 回顾分析栗刺所致眼外伤256例（256眼）.位置各异、深浅不一、数目不等的角膜、结膜、巩膜异物伤及穿孔伤为其基本特点,部分病例合并有角膜感染、前房积血、晶状体破裂、继发性青光眼、玻璃体积血、睫状体脱离、全葡萄膜炎和感染性眼内炎等.在明确诊断后,分步骤在裂隙灯显微镜或手术显微镜摘出栗刺异物,并对相关并发症采用药物治疗或手术治疗.结果 256例中,单纯异物伤198例在异物剔除后给予抗炎营养角膜等对症治疗,视力恢复到术前视力,或视力下降在两行以内;25例角膜细菌感染预后较好,3例真菌感染预后较差;9例前房积血和7例玻璃体积血经药物治疗恢复良好;13例晶状体刺伤、破裂中5例晶状体浑浊不明显,仍在随访观察,其余8例中有5例继发青光眼,分别于受伤后6d～3个月行超声乳化＋人工晶状体植入术,术后眼压控制,视力恢复至0.4 ～1.0;2例睫状体脱离的原因均为栗刺经巩膜刺伤睫状冠部或平坦部引发的出血性脱离,药物治疗2个月后恢复.1例全葡萄膜炎药物治疗后视力由眼前指数恢复到1.0.2例感染性眼内炎视力恢复较差,分别为眼前手动和0.04.结论 栗刺相关性眼外伤为陕西商洛地区常见的眼外伤,推测其年发病率超过1/10000.多发于中年男性,男女比例约9∶1.主要表现为角膜异物伤,严重病例还合并角膜感染、前房积血、晶状体刺伤破裂、继发性青光眼甚至眼内炎等.在受伤后及时就诊,积极进行药物联合手术治疗,对改善预后至关重要.加强防护意识,作业时戴草帽或防护眼镜为有效的预防措施.     

眼内异物的手术治疗

目的探讨眼内异物的手术治疗方法及其临床效果。方法对21例(21眼)眼内异物进行回顾性研究。根据眼内异物的不同位置、不同性质和并发症的种类而采取4种不同的术式摘出异物:原路异物摘出术;经睫状体平坦部磁铁吸出术;经后巩膜切口直接磁铁吸出术;玻璃体切除异物摘出术。摘出异物后处理相关的眼前、后段损伤。结果21例眼内异物全部摘出成功。术后1月矫正视力:光感1眼,0.05~0.2者11眼,0.3~1.0者9眼。结论根据眼内异物的位置、性质、大小及并发症采取不同的手术方式,保证了异物的成功摘出,并避免了手术并发症、保持或恢复有效的视力。     

眼内巨大异物摘出联合晶状体玻璃体视网膜手术

目的　探讨经前房通过巩膜隧道切口摘出眼内巨大异物联合晶状体玻璃体视网膜手术的临床疗效及术式选择。方法　分析12例(12眼)眼内巨大异物摘出病例,联合晶状体切除、玻璃体切除及视网膜手术。采用常规睫状体平坦部三切口闭合式玻璃体切除联合晶状体切除、巩膜垫压、环扎、气液交换、硅油填充及眼内光凝等,异物通过巩膜隧道切口用异物镊经前房夹出。结果　12眼异物均一次摘出成功,摘出成功率10 0 %。手术后并发症主要有出血、角膜水肿等。术后视力下降1眼,不变1眼,好转10眼。结论　经前房通过巩膜隧道切口摘出巨大眼内异物联合晶状体玻璃体视网膜手术安全、有效,术后角膜散光小,有利于视功能的恢复,可减少术后并发症的发生。     

眼球贯通伤的特点及治疗体会

目的 探讨眼球贯通伤的临床特点及治疗方法.方法 采用回顾性分析法.对2004年5月至2012年8月期间诊治的眼球贯通伤患者8例(8只眼),分析其临床特点及治疗效果.随访3～18个月.结果 8例术后最佳矫正视力均有不同程度的提高.其中,2例球壁异物均摘出,4例眶内球外异物存留;1例缝合的后巩膜伤口愈合好,7例未缝合的后巩膜伤口由瘢痕组织封闭.随诊期间未发生并发症.结论 出口异物嵌在球壁需摘出,在眶内球外可不必强行摘出.后巩膜伤口一般不需缝合.二期玻璃体切除术是治疗眼球贯通伤有效方法,伤后7～14d是理想地手术时机.     

玻璃体切除联合眼内异物摘出术的临床分析

目的 探讨玻璃体切除联合眼内异物摘出的手术时机和手术方法。方法 对经睫状体平坦部玻璃体切除联合眼内异物摘出术30例（30眼）进行回顾性分析。结果 本组30例（30眼）眼内异物均一次手术摘出，其中27例采用经睫状体平坦部玻璃体切除取出异物；1例锯齿缘附近磁性大异物，经玻璃体切割后，从巩膜切口用磁铁将异物吸出；1例锯齿缘巨大非磁性异物，行晶体摘除后经角膜缘切口取出。本组病例术后视力改善19眼（63．3％），无变化6眼（20％），视力下降5眼（16．7％）。早期视力下降的原因与术后角膜水肿，视网膜出血，玻璃体混浊、玻璃体腔内填充物等因素有关。术后有3例（3眼，1％）发生视网膜脱离，其中1例行巩膜扣带术＋玻璃体切除＋晶体切除＋冷凝＋注气术后治愈，1例放弃治疗；1例因眼球萎缩行眼球摘出。结论 对穿通伤口小且已自行闭合者、穿通伤口已缝合但角膜透明不影响观察者和有化脓性眼内炎征象者均应尽早手术。对于＜35岁晶体已混浊者，建议采取玻璃体切割切除晶体和眼内异物摘出同时进行，术中应尽量保留晶体前囊膜，以利于人工晶体植入。对位于周边部的非磁性异物，虹膜后粘连瞳孔无法扩大者建议术中切除晶体，以扩大视野有利于异物的寻找取出和病变玻璃体的切除。对巩膜裂伤伴球内异物存留的患者，建议玻璃体切除的同时行巩膜扣带术以降低视网膜脱离的风险。     

玻璃体视网膜手术治疗眼内后段异物伤

目的 评价玻璃体视网膜手术治疗眼内后段异物伤的疗效。方法 对17例(17只眼)眼内后段异物伤患者施行玻璃体切除、晶状体切除、眼内异物取出、眼内光凝、眼内充填术，部分病例结合巩膜外环扎等联合手术。结果 一次性异物摘出率100％。术后视力提高12只眼，不变4只眼，下降1只眼。结论 应用玻璃体视网膜手术治疗眼内后段异物伤，具有异物摘出成功率高，有利于及时处理并发症和恢复有用视力。     

板栗刺致眼外伤186例临床分析

目的总结186例（188眼）板栗刺致眼异物伤的治疗经验及疗效观察。方法表麻后在显微镜下用一次性注射针头剔除角膜异物和局麻后切开结膜或角膜缘取出结膜下、巩膜异物或前房异物（板栗刺），术后进行预防感染治疗。结果186例（188眼）眼球板栗刺1次取出者占87．77％，分2次取出者占12．23％，剔除后视力无影响者168例（170眼）占90．43％。结论板栗刺致眼异物伤应及时诊治，取出方法得当，术后预防感染，预后良好。     

角膜板栗刺异物伤15例的临床观察

目的：探讨目前角膜板栗刺异物伤有效治疗方法及影响病情进展的因素。方法：回顾性分析2014－07／2015－10武汉市同济医院眼科病房收治的角膜板栗刺异物伤患者15例15眼的临床资料,入院时未并发真菌性角膜炎的患者在剔除角膜板栗刺异物的同时均积极给予以那他霉素为主的抗真菌治疗,而对入院时已并发真菌性角膜炎的患者予以氟康唑溶液前房冲洗和角膜基质层注药,必要时予以羊膜移植术或角膜移植术,总结上述治疗方法的有效性及影响病情进展的因素。结果：入院时未并发角膜溃疡病例11例,入院时平均病程为1～7（2．42±2．15）d,入院时已并发真菌性角膜溃疡病例4例,入院时病程为3～30（18．25±4．35）d。其中并发角膜溃疡病例板栗刺数量平均为4．5根,并均有板栗刺穿透角膜进入前房;未发生角膜溃疡病例板栗刺数量平均为3．5根,而只有28．5％病例有板栗刺穿透角膜进入前房。经抗真菌治疗和相应手术治疗后,所有病例均被判定为治疗有效。结论：影响角膜板栗刺异物伤病情进展的因素可能有板栗刺的数量、板栗刺是否穿透角膜进入前房、就诊时病程的长短、是否积极进行抗真菌治疗等。对已并发真菌性角膜炎的病例积极予以抗真菌药物能有效控制真菌性角膜炎的进展,为进一步行羊膜移植或角膜移植术创造有利条件。     

Ocular injuries by durian fruit

AIM: To report various ocular injuries caused by durian fruit. METHODS: Three cases of ocular injuries were described in young patients, due to accidental fall of durian fruit on the forehead and face, while they were taking rest/sleeping /playing under the durian tree. RESULTS: The ocular injuries observed were lacerating injury of cornea with iris incarceration, hyphema, superficial penetrating injury of sclera and angle recession glaucoma in the right eye of first patient; lacerating injury of cornea with iris prolapse in the left eye of second patient; subconjunctival haemorrhage, traumatic mydriasis and superficial penetrating injury of sclera, commotion retinopathy and macular edema in the left eye of third patient. Vision improved to normal in all the eyes following surgical/ medical/optical treatment. CONCLUSION: Evidence of penetrating injury (because of thorns) and blunt injury (because of weight) can be seen in the eyes when durian fruit falls on the face. Vision can be recovered fully with immediate and appropriate treatment in these cases. The ocular injuries can be prevented by educating the public to wear protective metal frame wide goggles and not to sleep/take rest under the durian tree.     

煤矿工人眼爆炸伤78例调查分析

目的探讨煤矿工人眼爆炸伤的特点和处理原则。方法分析78例(120眼)眼爆炸伤的临床资料。结果双眼伤42例(84眼)占70.00%,以角膜、巩膜穿孔伤、外伤性白内障、眼内异物和视网膜视神经损伤为多。34例(52眼)合并其他器官损伤,占43.33%。6眼行眼球摘除术(5.00%)。术后致盲率为24.17%(29眼),致残率为40.00%(48眼)。结论眼爆炸伤伤情复杂严重,致盲率高,多合并其他器官损伤。及时正确的治疗是改善预后的关键。     

复发性翼状胬肉33眼手术疗效观察

目的:观察复发性翼状胬肉不同手术方法的术后再复发率及并发症。方法:我院2006-11/2009-02对31例33眼复发性翼状胬肉患者(伴有睑球粘连,眼球运动不同程度受限者12眼)施行翼状胬肉切除、丝裂霉素创面贴敷、自体结膜(带蒂或游离)移植或羊膜移植手术,手术方式:彻底切除净胬肉组织,裸露巩膜创面以0.2g/L丝裂霉素C溶液浸湿的棉片贴敷3min后,用生理盐水冲洗干净。巩膜创面覆盖方法:上或(和)下方结膜转位移植26眼,颞上方结膜游离移植2眼,羊膜移植5眼。结果:随访9mo～3a,胬肉未复发28眼;轻度复发(鼻侧球结膜及结膜下组织充血增厚,但未长入角膜缘或长入角膜缘内≤2mm)5眼,复发率15%,其中结膜转位移植4眼,羊膜移植1眼;睑球粘连轻度复发3眼;术后并发结膜肉芽肿1眼,眼部干痛、有时红卡等不适症状5眼,无1例发生角膜、巩膜溶解。结论:翼状胬肉切除联合自体结膜移植或羊膜移植及丝裂霉素创面贴敷的手术方式能明显降低复发性翼状胬肉的术后再复发率。     

Immunosuppressive properties of tissues of the ocular anterior segment

To determine whether explants of various tissues comprising the anterior segment of individual normal eyes can display immunosuppressive properties in vitro, explants of iris/ciliary body, cornea, cornea-limbus, sclera and conjunctiva were prepared from single eyes of BALB/c mice and tested for their capacity to suppress alloantigen-driven T cell activation in vitro. Cultured explants of iris and ciliary body, and of cornea, but not sclera or conjunctiva, suppressed T cell activation in vitro. Similarly, the supernatants of cultured iris/ciliary body and cornea explants displayed immunosuppressive properties. Prostaglandins appeared to make a minor contribution to the inhibition observed. The authors conclude that certain tissues within the anterior segment of the eye (iris, ciliary body, cornea) contain cells that secrete immunosuppressive factors, whereas other tissues (conjunctiva, sclera) lack this feature. The secretions of the former tissues undoubtedly contribute to the immunosuppressive features of the microenvironment in the anterior segment of the eye, and help to account for the existence of immune privilege.     

Management of intrascleral chestnut burr spines under ultrasound biomicroscopy guidance

Purpose:To explore the efficacy of ultrasound biomicroscopy (UBM) as a tool for detecting and localizing intrascleral chestnut burr spines.Methods:Individuals who were diagnosed with definitive or suspected intrascleral chestnut burr injuries between 2019 and 2020 were retrospectively reviewed. All patients underwent UBM to detect potential intrascleral spines. UBM imaging features were recorded and analyzed. Intrascleral spines were removed based upon UBM-guided localization. Patient clinical profiles, management, and treatment outcomes were recorded.Results:A total of 10 eyes (10 patients; 6 males, 4 females) were diagnosed with intrascleral spines over the study period, with an average patient age of 55 years (range: 39–71). Three of these 10 eyes exhibited involvement of the palpebrae and cornea, whereas three exhibited corneal involvement, and the remaining four patients exhibited only intrascleral spine injuries owing to their having undergone previous intracorneal spine extraction procedures. UBM features consistent with chestnut burr spines manifest a hyperechoic spot with a shadow. UBM enabled the precise localization of these spines and thus ensured their successful removal via a single surgery. During follow-up, two patients experienced vitreous hemorrhage due to a penetrating injury into the ciliary body that was gradually absorbed. All patients with eye irritation and red eyes progressed favorably, and no surgical complications were recorded.Conclusion:A retained scleral chestnut burr spine should be suspected if a patient complains of persistent eye irritation following intracorneal spine removal. UBM may be a valuable tool for detecting spines retained in the sclera, enabling the successful removal thereof.     

Latanoprost eye drops increase concentration of glycosaminoglycans in posterior rabbit sclera.

PURPOSE: Glycosaminoglycans are important components of ocular tissues such as the sclera. The pressure reducing effect of a new antiglaucoma drug, latanoprost, is based on an increase in the uveo-scleral outflow by way of modulation of the intracellular matrix of the ciliary body. The purpose of the study was to test the effect of latanoprost on the content of glycosaminoglycans in rabbit cornea and sclera. METHODS: Twelve rabbits were studied. Six rabbits were treated for 12 weeks with latanoprost eye drops and 6 with hydroxypropylmethylcellulose, dextran 70 eye drops for control. Samples were taken from cornea and anterior, lateral, and posterior sclera. Glycosaminoglycans were determined quantitatively by spectrophotometry (uronic acids). RESULTS: A significant increase in the concentration of uronic acids was found in all three localisations of sclera from latanoprost-treated animals. The increase was 26%, 24%, and 20% in anterior, lateral, and posterior sclera, respectively. CONCLUSIONS: Long-term treatment with latanoprost induces biochemical changes in sclera. The results indicate that topically applied latanoprost reaches the posterior parts of the rabbit eye.